title: Monochorionic quadramniotic quadruplets: sonographic workup.
abstract: OBJECTIVE
  We raise the issue of scanning multifetal pregnancies of higher order as early as possible. A rare case of monochorionic/quadramniotic pregnancy seeking multifetal pregnancy reduction and its clinical management is presented.
  
  
  METHODS
  Transabdominal scanning at 16 weeks was performed correctly diagnosing the monochorionic quadruplet pregnancy.
  
  
  RESULTS
  Suspecting vascular connections between the placentae, the fetal reduction was declined. The patient was delivered at 31 weeks. The 4 female neonates survived with slight ventilatory assistance.
  
  
  CONCLUSIONS
  Multifetal pregnancies in general, but those of higher order in particular, have to be scanned as early as 8-10 weeks to correctly and easily assign their chorionicity and amnionicity. The case of a monochorionic/quadramniotic pregnancy and its clinical course are presented.
authors.affiliation: Columbia-Presbyterian Medical Center, Sloane Hospital for Women, Department of Obstetrics and Gynecology, New York, NY 10032, USA.
authors.forename: I E
authors.initials: IE
authors.lastname: Timor-Tritsch
authors.forename: A
authors.initials: A
authors.lastname: Fleischer
authors.forename: A
authors.initials: A
authors.lastname: Monteagudo
authors.forename: E
authors.initials: E
authors.lastname: Valderrama
mesh_terms: D000328:Adult; D000650:Amnion / Q000000981:diagnostic imaging* / Q000473:pathology; D002823:Chorion / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011783:Quadruplets; D016216:Ultrasonography, Prenatal